About this notice
This notice describes how medical information about you may be used and disclosed, and how you can get access to that information. Please review it carefully. Federal law requires us to maintain the privacy of your protected health information, to give you this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.
How we may use and disclose your health information
Without your written authorization, we may use or disclose your information for:
- Treatment — sharing information with other clinicians involved in your care, including the provider who referred you and any clinician we refer you to.
- Payment — verifying coverage, submitting claims to your health plan as an out-of-network provider, obtaining reimbursement, and preparing a superbill at your request.
- Health care operations — quality review, staff training, and administration of the practice.
- Appointment reminders and care contact — contacting you by the phone, text, or email method you selected about appointments and your care.
- Business associates — sharing information with companies that perform services for the practice, such as the patient management system we use to receive and respond to appointment requests. These companies are contractually required to safeguard your information and to use it only for the services they perform for us.
- As required by law — including reporting to the Arizona Controlled Substances Prescription Monitoring Program, public health and communicable disease reporting, mandatory reporting of suspected abuse or neglect, responses to subpoenas and other lawful process, and disclosures to avert a serious threat to health or safety.
Uses that require your written authorization
We will obtain your written authorization before using or disclosing your information for marketing, before any sale of information, and before disclosing psychotherapy notes where those exist. The optional “practice news” box on our patient forms is how you give that authorization for practice news; leaving it unchecked means we send you nothing but appointment and care messages. You may revoke an authorization in writing at any time, except to the extent we have already acted in reliance on it.
Your rights
You have the right to:
- Inspect and obtain a copy of your medical record, in paper or electronic form.
- Request a correction to information you believe is incorrect or incomplete.
- Request that we communicate with you at an alternative address or phone number.
- Request restrictions on certain uses and disclosures, including a restriction on disclosure to a health plan for services you pay for out of pocket, which we must honor.
- Receive an accounting of certain disclosures we have made.
- Receive a paper copy of this notice on request, even if you agreed to receive it electronically.
- Be notified if a breach of your unsecured protected health information occurs.
How to exercise your rights
Submit your request in writing to the Privacy Officer at the address below, or ask our front desk for the appropriate form. We will respond within 30 days. If we need more time, we will tell you in writing and explain why.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer, or with the U.S. Department of Health and Human Services Office for Civil Rights at hhs.gov/ocr/privacy/hipaa/complaints. We will not retaliate against you for filing a complaint.
Changes to this notice
We reserve the right to change this notice and to make the revised notice effective for information we already hold as well as information we receive in future. The current notice is always posted on this page and available in our office.
Contact
Privacy Officer · Canyon Pain Center, 702 E Bell Rd, Suite 112, Phoenix, AZ 85022 · (602) 603-2282 · info@canyonpaincenter.com